Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00947800 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00947800 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00947800 | NJ |
NPI | 1053951186 |
---|---|
Provider Name | Shirley Sabado Santos |
First Address | Mine Hill, NJ 07803-3216 |
Second Address | Maplewood, NJ 07040-3437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2020 |
Last Update Date | 07/01/2020 |